The British Vein Institutehttp://www.bvi.uk.com
Expert Treatment of Varicose Veins and Thread VeinsFri, 04 Jul 2014 13:09:48 +0000en-UShourly1http://wordpress.org/?v=4.0.1Foam Sclerotherapy for Varicose Veinshttp://www.bvi.uk.com/media/media-for-professionals/foam-sclerotherapy-varicose-veins/
http://www.bvi.uk.com/media/media-for-professionals/foam-sclerotherapy-varicose-veins/#commentsTue, 10 Sep 2013 12:32:28 +0000http://bvi.ecsid01.ecssrv.net/?p=1087A substantial change in medical practice has occurred in the last 10 years. Several new, minimally invasive techniques for treating have been described and come into general use. The main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre leading to a much more rapid recovery from treatment. Ultrasound Guided Foam Sclerotherapy has become well established as a method of achieving long term cure of varicose veins. The National Institute for Health and Clinical Excellence (NICE) now recommends the use of modern minimally invasive treatments for varicose veins instead of surgery.
]]>http://www.bvi.uk.com/media/media-for-professionals/foam-sclerotherapy-varicose-veins/feed/0Foam Sclerotherapy for Varicose Veins – A Patient's Viewhttp://www.bvi.uk.com/media/media-for-patients/foam-sclerotherapy-varicose-veins-patients-view/
http://www.bvi.uk.com/media/media-for-patients/foam-sclerotherapy-varicose-veins-patients-view/#commentsTue, 10 Sep 2013 12:29:48 +0000http://bvi.ecsid01.ecssrv.net/?p=1084A substantial change in medical practice has occurred in the last 10 years. Several new, minimally invasive techniques for treating have been described and come into general use. The main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre leading to a much more rapid recovery from treatment. Ultrasound Guided Foam Sclerotherapy has become well established as a method of achieving long term cure of varicose veins. The National Institute for Health and Clinical Excellence (NICE) now recommends the use of modern minimally invasive treatments for varicose veins instead of surgery.
]]>http://www.bvi.uk.com/media/media-for-patients/foam-sclerotherapy-varicose-veins-patients-view/feed/0Varicose Veins Todayhttp://www.bvi.uk.com/media/published-medical-articles/varicose-veins-today/
http://www.bvi.uk.com/media/published-medical-articles/varicose-veins-today/#commentsTue, 08 Nov 2011 13:57:50 +0000http://wordpress.ecscdn.net/varicoseveins/?p=286A decade ago a doctor’s advice to a patient with varicose veins was easy: the alternatives are injection sclerotherapy or surgery. Only these techniques have existed long enough to know about both their shortand long-term results. Results have generally been disappointing, with high recurrence rates as time goes by1. The past few years have witnessed an explosion in types of minimally invasive treatment technique and this has made decisions about varicose vein treatment more difficult. These techniques include thermal ablation in the form of endovenous laser ablation or radiofrequency ablation (RFA), and foam sclerotherapy.

The introduction of these new methods has been rapid, before any adequate scientific evaluation. It is based on the enthusiasm of practitioners and some short-term trials that demonstrate equivalence of outcome with conventional surgery, but with less postoperative discomfort and speedier return to normal activity. In addition, the new techniques can be employed under local anaesthetic, often in an outpatient setting, thereby freeing operating theatre time and potentially improving cost efficacy. Increasing access to information has encouraged patients to seek these new treatments, often after visiting commercially sponsored websites. Many feel bewildered by the available choice, while being seduced by the prospect of involvement in decision making.

This study is a prospective randomised controlled trial comparing sapheno-femoral ligation, great saphenous stripping and multiple avulsions with sapheno-femoral ligation and ultrasound guided foam sclerotherapy to the saphenous vein. Primary end points were patient recovery period and quality of life and secondary end points frequency of complications on the two arms of the trial and the cost of the treatment. Material and method. Sixty patients with primary varicose veins due to GSV incompetence and suitable for day case surgery were randomly allocated to undergo ultrasound-guided sclerotherapy with sapheno-femoral ligation under local anaesthesia (nZ30) or sapheno-femoral ligation, stripping and multiple avulsions under general anaesthesia (nZ30). The study protocol included history, physical examination, assignment of CEAP class and assessment venous clinical severity score (VCSS), completion of the aberdeen vein questionnaire (AVQ) and colour duplex ultrasound.

Results:

All treatments were completed as intended. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days) (p!0.001, Mann–Whitney). AVQ score was also significantly reduced at 3 months by 46% in the sclerotherapy group, and by 40% in the conventional surgery group (p!0.001, Wilcoxon).

The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 45 vs. 85 min (p!0.001, Mann–Whitney). The overall cost of the procedure in the sclerotherapy group (£672.97) was significantly less compared to conventional surgery (£1120.64).

At 3 weeks, there was no statistical difference in the complication rate between the two groups. At 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups and the median VCSS score dropped from five to one in group one and from seven to three in group two (p!0.001, Wilcoxon test). In group one four patients (13%) had a recanalised vein which needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 87%. Conclusion. Ultrasound guided sclerotherapy combined with sapheno-femoral ligation was less expensive, involved a shorter treatment time and resulted in more rapid recovery compared to sapheno-femoral ligation, saphenous stripping and phlebectomies.

The aim was to explore the current experience and practice of vascular surgeons in the United Kingdom and Ireland regarding foam sclerotherapy for varicose veins.

Method:

A postal questionnaire was sent to 609 members of the Vascular Society of Great Britain and Ireland.

Results:

There were 281 responses (47%). Seventy surgeons (25%) used foam sclerotherapy. Most use it selectively; few (29%) offer it to all patients. It was more likely to be used for recurrent varices (71%), in older patients (61%) and for smaller non-saphenous varices (67%). The majority of surgeons (69%) used sodium tetradecyl sulphate and up to a maximum of 10e12 ml of foam. The majority used ultrasound guidance (95%), leg elevation (69%) and direct pressure over the saphenofemoral or saphenopopliteal junction during injection (63%). Eighty per cent used compression bandaging after treatment, usually for 7 days (44%). Ninety percent advised compression stockings, usually Class II (64%) for 14 days (39%). Serious complications were few, but eleven surgeons had seen a deep vein thrombosis, two had seen a patient with a stroke and one a transient ischaemic attack.

Conclusion:

Foam sclerotherapy was used by a quarter of surgeons who replied to the survey. Aspects of technique varied considerably and studies to determine optimal techniques are needed. Serious complications with the technique were rare.

Varicose veins are a relatively common condition and account for around 54,000 in-patient hospital episodes per year. The two most common interventions for varicose veins are surgery and sclerotherapy. However, there is little comparative data regarding their effectiveness. Objectives To identify whether the use of surgery or sclerotherapy should be recommended for the management of primary varicose veins.

Selection Criteria:

All studies that were described as randomised controlled trials comparing surgery with sclerotherapy for the treatment of primary varicose veins were identified. Data collection and analysis Two authors independently extracted and summarised data from the eligible studies using a data extraction sheet for consistency. All studies were cross-checked independently by the authors.

Main Results:

A total of 2306 references were found from our searches, 61 of which were identified as potential trials comparing surgery and sclerotherapy. However, only nine randomised trials, described in a total of 14 separate papers, fulfilled the inclusion criteria. Fifty trials were excluded and one trial is ongoing and is due for completion in 2004. The trials used a variety of outcome measures and classification systems which made direct comparison between trials difficult. However, the trend was for sclerotherapy to be evaluated as significantly better than surgery at one year; after one year (sclerotherapy resulted in worse outcomes) the benefits with sclerotherapy were less, and by three to five years surgery had better outcomes. The data on cost-effectiveness was not adequately reported.

Authors Conclusions:

There was insufficient evidence to preferentially recommend the use of sclerotherapy or surgery. There needs to be more research that specifically examines both costs and outcomes for surgery and sclerotherapy.

Increasing interest in foam sclerotherapy (FS) for saphenous insufficiency has highlighted the need to study the side-effects and complications of this treatment. The aim of this study is to better assess their nature and incidence.

Methods:

A multicentre, prospective and controlled study was carried out in which patients treated with FS for great (GSV) and small saphenous veins (SSV) trunk incompetence were included. Immediate untoward events were reported. Duplex ultrasound (DUS) examination was carried out to assess all patients between the eighth and 30th day. In addition, 20% of patients were called by an external auditor.

Results:

In total, 818 GSV and 207 SSV were treated in 1025 patients in 20 phlebology clinics. Ninety-nine percent of patients were controlled with DUS and non-duplex-checked patients were all called. The saphenous trunk was occluded in 90.3% of patients. Twenty-seven (2.6%) side-effects were reported: migraine (n ¼ 8, 4 with visual disturbance); visual disturbance alone (n ¼ 7); chest pressure alone (n ¼ 7); and chest pressure associated with visual disturbance (n ¼ 5). Eleven thrombo-embolic events occurred: 10 deep vein thrombosis (DVT) but only five in symptomatic patients, and one pulmonary embolism that occurred 19 days following the FS without DVT identified by DUS. One transient ischaemic stroke, with complete clinical recovery in 30 minutes, and one septicaemia with satisfactory outcome were reported as well.

Conclusion:

This studydemonstrates in a large sample ofpatients a lowrate of adverse reactions after FS of great and small saphenous trunks. However, but the eventuality of exceptional but more serious complications has to be taken into account in the management of patients. A multicentre study like this one takes into account different practices and reports all possible complications, thus demonstrating the need for a common validated protocol.

Foam sclerotherapy has gained a great popularity among phlebologists worldwide, although a major lack of homogeneity in the material used to produce sclerosant foam (SF) and to inject SF has been reported. Aims: To highlight the literature data and a few personal clinical and experimental outcomes concerning the main variables in SF production and injection.

Methods:

A review of the published literature and of our own 12 year clinical and experimental experience has been undertaken in order to focus on a few variables of the material and methods used to produce SF with Tessari method and to inject SF.

Results:

In SF production, differences in gas components, liquid to gas ratio, as well in disposable material can variably influence the resulting SF. Similarly SF injection through ultrasound guidance, with needle, or with short/long catheter may exhibit different foam behaviours according to the variable material and techniques which are employed. More recently the introduction of long catheters, possibly together with hook phlebectomy, seems to potentiate the short-mid term outcomes of foam sclerotherapy.

Conclusion:

SF formation is greatly influenced by the choice of the gas component, the liquidto- gas ratio, the type of syringes; also larger needles are to be preferred for injection of SF, while long catheters seem to represent a valid alternative especially when combined with tumescence to minimise saphenous diameter.

The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods: A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound.

Results:

No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent.

Conclusion:

The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

Ultrasound guided foam sclerotherapy (UGFS) is a minimally invasive treatment for varicose veins (VV) whose clinical and cost-effectiveness remains incompletely defined. The aim of the current study was to examine patients’ expectations before and satisfaction after UGFS for VV in terms of relief of lower limb symptoms, improvement in appearance, and beneficial effect on life-style.

Methods:

A consecutive series of 351 patients (464 limbs) undergoing UGFS for VV completed questionnaires one week prior to and six months after treatment.

Results:

Pre and post-treatment response rates were 80%; 60% returned both questionnaires. Virtually all patients were expecting improvement in lower limb symptoms; these were exceeded in a third. Most patients expected cosmetic improvement and these were largely met. Two-thirds of patients expected significant life-style (clothes, work, social) benefits and outcomes were slightly less than expected. A quarter expected improvement in their interpersonal relationships. This benefit was greater than expected occurring in one-third of patients. Overall, a quarter of patients had their expectations exceeded and 10% (appearance and relationships) to 25% (clothing, work and social and leisure activities) were left with unmet expectations.

Discussion:

When specifically asked most patients admit to having a wide range of expectations in relation to their VV treatment, many of them probably unanticipated by the clinician. However, present data indicate that UGFS is usually able to meet, and often exceeds, these physical and psychosocial needs and expectations. UGFS is, therefore, a highly effective treatment for VV from the patients’ perspective.